# BAY AREA MODERN DENTISTRY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134702111
- **Authorized official:** IVO BUSHATI DMD (DENTIST)
- **Authorized official phone:** (727) 547-8227

## Contact information

- **Practice address:** 5299 PARK BLVD N, PINELLAS PARK, FL 33781-3418
- **Practice address phone:** (727) 547-8227
- **Mailing address:** 506 20TH AVE NE, ST PETERSBURG, FL 33704-4622
- **Mailing address phone:** (727) 686-1808

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 04/28/2021
- **Last updated:** 04/28/2021